Healthcare Provider Details

I. General information

NPI: 1568919314
Provider Name (Legal Business Name): NGUYEN THAO HUYNH RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2016
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20220 N 59TH AVE
GLENDALE AZ
85308-6844
US

IV. Provider business mailing address

20220 N 59TH AVE
GLENDALE AZ
85308-6844
US

V. Phone/Fax

Practice location:
  • Phone: 623-825-3311
  • Fax: 623-825-3344
Mailing address:
  • Phone: 623-825-3311
  • Fax: 623-825-3344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberS022141
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: